Preoperative breast MR imaging in newly diagnosed breast cancer: Comparison of outcomes based on mammographic modality,breast density and breast parenchymal enhancement

PurposeTo compare the role of MR for assessment of extent of disease in women newly diagnosed with breast cancer imaged with digital mammography (DM) alone versus digital breast tomosynthesis (DBT).MethodsRetrospective review was conducted of 401 consecutive breast MR exams (10/1/2013–7/31/2015) from women who underwent preoperative MR for newly diagnosed breast cancer by either DM or DBT, leaving 388 exams (201 DM and 187 DBT). MR detection of additional, otherwise occult, disease was stratified by modality, breast density, and background parenchymal enhancement. A true-positive finding was defined as malignancy in the ipsilateral-breast >2 cm away from the index-lesion or in the contralateral breast.Results50 additional malignancies were detected in 388 exams (12.9%), 37 ipsilateral and 13 contralateral. There was no difference in the MR detection of additional disease in women imaged by either DM versus DBT (p = 0.53). In patients with DM, there was no significant difference in the rate of MR additional cancer detection in dense versus non-dense breasts (p = 0.790). However, in patients with DBT, MR detected significantly more additional sites of malignancy in dense compared to non-dense breasts (p = 0.017). There was no difference in false-positive MR exams (p = 0.470) for DM versus DBT. For both DM and DBT cohorts, higher MR background parenchymal enhancement was associated with higher false-positive (p = 0.040) but no significant difference in true-positive exams.ConclusionsAmong patients with DBT imaging at cancer diagnosis, women with dense breasts appear to benefit more from preoperative MR than non-dense women. In women imaged only with DM, MR finds additional malignancy across all breast densities.     

The effect of different exposure parameters on radiation dose in digital mammography and digital breast tomosynthesis: A phantom study

IntroductionThere are concerns regarding the increase in radiation dose among women undergoing both digital mammography (DM) and digital breast tomosynthesis (DBT). The aim of this study was to evaluate the effect of different exposure parameters on entrance skin dose (ESD) and average glandular dose (AGD) for DM and DBT using a phantom.MethodsThe ESD and AGD of 30 DM and DBT (cranio-caudal projection) examinations using a tissue equivalent phantom where acquired using a GE Senographe Essential DM unit. Commercial phantoms were used to simulate three different breast thicknesses and compositions. Tube potential, tube load, and target/filter combinations were also varied with ESD and AGD recorded directly from the DM unit. Comparisons were made using the non-parametric Kruskal Wallis, Mann–Whitney, and Wilcoxon signed rank tests.ResultsThe individual ESD values for 4 cm, 5 cm, and 6 cm thick phantoms for DM and DBT at Rh/Rh target/filter combination and 30–32 kV/56 mAs levels were 5.06 and 4.18 mGy; 5.82 and 5.08 mGy; and 7.26 and 11.4 mGy, respectively; while AGDs were 1.57 and 1.30 mGy, 1.33 and 1.39 mGy; and 1.29 and 3.60 mGy, respectively. The Kruskal–Wallis test showed a statistically significant difference in AGD for DM (P = .029) but not for DBT (P = 0.368). The Mann–Whitney and Wilcoxon signed rank tests showed no statistically significant difference for ESD or AGD between both DM and DBT techniques (P = .827 and .513). The percentage differences in ESD for phantom thicknesses of 4 cm, 5 cm, and 6 cm between DBT and DM ranged between −21% and 36%; while for AGD between −21% and 64.2%.ConclusionsThe ESD and AGD for single view projection in DM and DBT showed differences at 4 and 6 cm breast thicknesses and compositions but not at 5 cm thickness with 30–32 kV and a Rh/Rh target/filter combination.Implications for practiceA fibro-fatty breast results in less radiation dose variations in terms of ESD and AGD between DM and DBT techniques.     

A randomised trial of screening with digital breast tomosynthesis plus conventional digital 2D mammography versus 2D mammography alone in younger higher risk women

IntroductionDigital breast tomosynthesis (DBT) has been shown to increase invasive cancer detection rates at screening compared to full field digital (2D) mammography alone, and some studies have reported a reduction in the screening recall rate. No prospective randomised studies of DBT have previously been published. This study compares recall rates with 2D mammography with and without concurrent DBT in women in their forties with a family history of breast cancer undergoing incident screening.Materials and methodsAsymptomatic women aged 40–49 who had previously undergone mammography for an increased risk of breast cancer were recruited in two screening centres. Participants were randomised to screening with 2D mammography only at the first study screen followed a year later by screening with 2D plus DBT, or vice versa. Recall rates were compared using an intention to treat analysis. Reading performance was analysed for the larger centre.Results1227 women were recruited. 1221 first screens (604 2D, 617 2D + DBT) and 1124 second screens (558 2D + DBT, 566 2D) were analysed. Eleven women had screen-detected cancers: 5 after 2D, 6 after 2D + DBT. The false positive recall rates were 2.4% for 2D and 2.2% for 2D + DBT (p = 0.89). There was a significantly greater reduction between rounds in the number of women with abnormal reads who were not recalled after consensus/arbitration with 2D + DBT than 2D (p = 0.023).ConclusionThe addition of DBT to 2D mammography in incident screening did not lead to a significant reduction in recall rate. DBT may increase reader uncertainty until DBT screening experience is acquired.     

Accuracy of Digital Breast Tomosynthesis for Detecting Breast Cancer in the Diagnostic Setting: A Systematic Review and Meta-Analysis

ObjectiveTo compare the accuracy for detecting breast cancer in the diagnostic setting between the use of digital breast tomosynthesis (DBT), defined as DBT alone or combined DBT and digital mammography (DM), and the use of DM alone through a systematic review and meta-analysis.Materials and MethodsOvid-MEDLINE, Ovid-Embase, Cochrane Library and five Korean local databases were searched for articles published until March 25, 2020. We selected studies that reported diagnostic accuracy in women who were recalled after screening or symptomatic. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to estimate pooled sensitivity and specificity. We compared the diagnostic accuracy between DBT and DM alone using meta-regression and subgroup analyses by modality of intervention, country, existence of calcifications, breast density, Breast Imaging Reporting and Data System category threshold, study design, protocol for participant sampling, sample size, reason for diagnostic examination, and number of readers who interpreted the studies.ResultsTwenty studies (n = 44513) that compared DBT and DM alone were included. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.86–0.93) and 0.90 (95% CI 0.84–0.94), respectively, for DBT, which were higher than 0.76 (95% CI 0.68–0.83) and 0.83 (95% CI 0.73–0.89), respectively, for DM alone (p < 0.001). The area under the summary receiver operating characteristics curve was 0.95 (95% CI 0.93–0.97) for DBT and 0.86 (95% CI 0.82–0.88) for DM alone. The higher sensitivity and specificity of DBT than DM alone were consistently noted in most subgroup and meta-regression analyses.ConclusionUse of DBT was more accurate than DM alone for the diagnosis of breast cancer. Women with clinical symptoms or abnormal screening findings could be more effectively evaluated for breast cancer using DBT, which has a superior diagnostic performance compared to DM alone.     

Digital Breast Tomosynthesis versus MRI as an Adjunct to Full-Field Digital Mammography for Preoperative Evaluation of Breast Cancer according to Mammographic Density

ObjectiveTo compare digital breast tomosynthesis (DBT) and MRI as an adjunct to full-field digital mammography (FFDM) for the preoperative evaluation of women with breast cancer based on mammographic density.Materials and MethodsThis retrospective study enrolled 280 patients with breast cancer who had undergone FFDM, DBT, and MRI for preoperative local tumor staging. Three radiologists independently sought the index cancer and additional ipsilateral and contralateral breast cancers using either FFDM alone, DBT plus FFDM, or MRI plus FFDM. Diagnostic performances across the three radiologists were compared among the reading modes in all patients and subgroups with dense (n = 186) and non-dense breasts (n = 94) according to mammographic density.ResultsOf 280 patients, 46 (16.4%) had 48 additional (39 ipsilateral and nine contralateral) cancers in addition to the index cancer. For index cancers, both DBT plus FFDM and MRI plus FFDM showed sensitivities of 100% in the non-dense group. In the dense group, DBT plus FFDM showed lower sensitivity than that of MRI plus FFDM (94.6% vs. 99.6%, p < 0.001). For additional ipsilateral cancers, DBT plus FFDM showed specificity and positive predictive value (PPV) of 100% in the non-dense group, but sensitivity and negative predictive value (NPV) were not statistically different from those of MRI plus FFDM (p > 0.05). In the dense group, DBT plus FFDM showed higher specificity (98.2% vs. 94.1%, p = 0.005) and PPV (83.1% vs. 65.4%; p = 0.036) than those of MRI plus FFDM, but lower sensitivity (59.9% vs. 75.3%; p = 0.049). For contralateral cancers, DBT plus FFDM showed higher specificity than that of MRI plus FFDM (99.0% vs. 96.7%, p = 0.014), however, the other values did not differ (all p > 0.05) in the dense group.ConclusionDBT plus FFDM showed an overall higher specificity than that of MRI plus FFDM regardless of breast density, perhaps without substantial loss in sensitivity and NPV in the diagnosis of additional cancers. Thus, DBT may have the potential to be used as a preoperative breast cancer staging tool.     

Double reading of automated breast ultrasound with digital mammography or digital breast tomosynthesis for breast cancer screening

PurposeTo evaluate the impact of double reading automated breast ultrasound (ABUS) when added to full field digital mammography (FFDM) or digital breast tomosynthesis (DBT) for breast cancer screening.MethodsFrom April 2014 to June 2015, 124 women with dense breasts and intermediate to high breast cancer risk were recruited for screening with FFDM, DBT, and ABUS. Readers used FFDM and DBT in clinical practice and received ABUS training prior to study initiation. FFDM or DBT were first interpreted alone by two independent readers and then with ABUS. All recalled women underwent diagnostic workup with at least one year of follow-up. Recall rates were compared using the sign test; differences in outcomes were evaluated using Fisher's exact test.ResultsOf 121 women with complete follow-up, all had family (35.5%) or personal (20.7%) history of breast cancer, or both (43.8%). Twenty-four women (19.8%) were recalled by at least one modality. Recalls increased from 5.0% to 13.2% (p = 0.002) when ABUS was added to FFDM and from 3.3% to 10.7% (p = 0.004) when ABUS was added to DBT. Findings recalled by both readers were more likely to result in a recommendation for short term follow-up imaging or tissue biopsy compared to findings recalled by only one reader (100% vs. 42.1%, p = 0.041). The cancer detection rate was 8.3 per 1000 screens (1/121); mode of detection: FFDM and DBT.ConclusionsAdding ABUS significantly increased the recall rate of both FFDM and DBT screening. Double reading of ABUS during early phase adoption may reduce false positive recalls.     

Accuracy in tumor size measurements: Comparison of digital mammography,digital breast tomosynthesis and synthetic mammography

PurposeThe aim of this study was to assess the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT) and synthetic mammography (SM) in tumor size measurements compared with histological tumor sizes.Materials and methods71 breast cancer patients who underwent DM and DBT acquisitions simultaneously were included in this study. One radiologist with 8 years of experience in breast imaging measured tumor sizes independently in three separate sessions which include DM, DBT and SM images, respectively. The correlations between the measured tumor sizes on each imaging technique and histological sizes were analyzed using Spearman correlation test. The patients were categorized into two subgroups according to assigned breast density categories (dense and non-dense), and histological tumor sizes (≤2 cm and > 2 cm). To assess the agreement levels between the measured tumor sizes and histological sizes Bland-Altman analyses were performed for each imaging technique.ResultsThe mean of histological size of tumors was 23.85 ± 16.57 mm (median: 20). The means of measured tumor sizes were 21.21 ± 13.59 mm (median: 19), 21.52 ± 13.42 mm (median: 19) and 18.97 ± 11.21 mm (median: 17) in DM, DBT and SM, respectively. The Spearman correlation values with histologic sizes were 0.814 (P < 0.001), 0.887 (P < 0.001), and 0.852 (P < 0.001) for DM, DBT and SM, respectively. In subgroup analyses, the correlation values showed decrement for tumors >2 cm in size compared to tumors ≤2 cm in size.ConclusionDBT provides the most accurate tumor size measurements among mammographic imaging techniques and if mammography will be used in tumor size measurements, DBT should be preferred.     

Comparison of digital mammography and digital breast tomosynthesis in the detection of architectural distortion

Objectives

To compare interobserver variability (IOV), reader confidence, and sensitivity/specificity in detecting architectural distortion (AD) on digital mammography (DM) versus digital breast tomosynthesis (DBT).

Methods

This IRB-approved, HIPAA-compliant reader study used a counterbalanced experimental design. We searched radiology reports for AD on screening mammograms from 5 March 2012–27 November 2013. Cases were consensus-reviewed. Controls were selected from demographically matched non-AD examinations. Two radiologists and two fellows blinded to outcomes independently reviewed images from two patient groups in two sessions. Readers recorded presence/absence of AD and confidence level. Agreement and differences in confidence and sensitivity/specificity between DBT versus DM and attendings versus fellows were examined using weighted Kappa and generalised mixed modeling, respectively.

Results

There were 59 AD patients and 59 controls for 1,888 observations (59?×?2 (cases and controls)?×?2 breasts?×?2 imaging techniques?×?4 readers). For all readers, agreement improved with DBT versus DM (0.61 vs. 0.37). Confidence was higher with DBT, p?=?.001. DBT achieved higher sensitivity (.59 vs. .32), p?<?.001; specificity remained high (>.90). DBT achieved higher positive likelihood ratio values, smaller negative likelihood ratio values, and larger ROC values.

Conclusions

DBT decreases IOV, increases confidence, and improves sensitivity while maintaining high specificity in detecting AD.

Key points

? Digital breast tomosynthesis decreases interobserver variability in the detection of architectural distortion.? Digital breast tomosynthesis increases reader confidence in the detection of architectural distortion.? Digital breast tomosynthesis improves sensitivity in the detection of architectural distortion.

     

数字乳腺X线摄影技术的研究进展

随着数字化乳腺X线检查技术的发展,屏/片系统乳腺X线摄影(SFM)技术已逐步被取代,一些技术改进的优势已在致密型乳腺的女性中得到证实。比较数字乳腺体层摄影(DBT)技术、对比增强双能数字乳腺X线摄影(CEDM)技术及常规数字乳腺X线摄影(DM)技术,并综述数字乳腺摄影技术发展中一些新技术的特点,分析其优势、局限性及对病人的潜在影响等,从而预测它们的发展前景。     

Breast tomosynthesis: A diagnostic addition to screening digital mammography

Objectives

Comparison between digital mammography alone and with adding digital breast tomosynthesis in breast cancer screening.

Assessment of the uterine dose in digital mammography and digital breast tomosynthesis

IntroductionDigital Mammography (DM-2D) and more recently Digital Breast Tomosynthesis (DBT), are two of the most effective imaging modalities for breast cancer detection, often used in screening programmes. It may happen that exams using these two imaging modalities are inadvertently performed to pregnant women. The objective of this study is to assess the dose in the uterus due to DM-2D and DBT exams, according to two main irradiation scenarios: in the 1st scenario the exposure parameters were pre-selected directly by the imaging system, while in the 2nd scenario, the maximum exposure parameters were chosen.MethodsThe mammography equipment used was a Siemens Mammomat Inspiration. A physical anthropomorphic phantom, PMMA plates (simulating a breast thickness of 6 cm) and thermoluminescent dosimeters (TLDs) were used to measure entrance air kerma values on the phantom's breast and abdomen in order to successively estimate the mean glandular dose (MGD) and the dose in the uterus. For the two irradiation scenarios chosen, two-breast imaging modalities were selected: 1) DBT in Cranio-Caudal (CC) view (with 28 kV and 160 mAs as exposure parameters), 2) DBT and DM in Medio Lateral-Oblique (MLO) and CC views (with 34 kV and 250 mAs as exposure parameters).ResultsIn the 1st scenario, the TLD measurements did not detect significant dose values in the abdomen whereas the MGD estimated using the D.R. Dance model was in close agreement with data available in the literature. In the 2nd scenario, there was no significant difference in MGD estimation between the different views, whereas the air kerma values in the abdomen (in DBT mode, CC and MLO) were 0.049 mGy and 0.004 mGy respectively. In CC DM-2D mode the abdomen air kerma value was 0.026 mGy, with no significant detected value in MLO view.ConclusionsFor the dose in the uterus, the obtained values seem to indicate that DM-2D and DBT examinations inadvertently performed during pregnancy do not pose a significant radiological risk, even considering the case of overexposure in both breasts.Implications for practiceThe accurate knowledge of the doses in DM-2D and DBT will contribute to raise the awareness among medical practitioners involved in breast imaging empowering them to provide accurate information about dose levels in the uterus, improving their radiation risk communication skills and consequently helping to reduce the anxiety of pregnant women undergoing this type of examinations.     

数字乳腺摄影计算机辅助诊断对乳腺癌的检出价值

目的：探讨全数字化乳腺摄影（DM）计算机辅助诊断（CAD）在不同乳腺结构内检出乳腺癌的价值。方法：185例经病理证实的单乳单灶性乳腺癌及179例正常乳腺均行DM检查,根据BI-RADS将所有乳腺分为非致密组和致密组。将所有乳腺摄影图像采用CAD法进行诊断,计算CAD的诊断敏感性,记录CAD在病例组及正常组的平均每例假阳性标记数,并进行不同结构乳腺组间及病例组与正常组的比较。结果：CAD检出乳腺癌的敏感度为88．6％;在非致密组与致密组中检出乳腺癌的敏感度分别为97．4％和82．4％,两组比较,差异具有统计学意义（P〈0．05）。在病例组和正常组中cAD的假阳性标记数的中位数（最小值,最大值）分别为1（0,12）个和2（0,8）个,两组间的差异有统计学意义（P〈0．05）。结论：cAD检出乳腺癌的敏感性较高,乳腺密度可能影响DM对单纯肿块型乳腺癌的检出。     

BI-RADS 3 on dense breast screening ultrasound after digital mammography versus digital breast tomosynthesis

ObjectiveCompare the BI-RADS 3 rate and follow-up of dense breast ultrasound (US) screening following digital mammography (DM) versus digital breast tomosynthesis (DBT).MethodsIRB-approved, HIPAA compliant retrospective search was performed of databases at two tertiary breast centers and an office practice for BI-RADS 3 screening US examinations performed 10/1/14–9/30/16. Prior DM versus DBT, downgrade and upgrade rate, and timing and pathology results were recorded. Differences were compared using the two-sample proportions test.Results3183 screening US examinations were performed, 1434/3183 (45.1%) after DM and 1668/3183 (52%) after DBT (2.5% (81/3183) no prior mammogram available). 13.9% (199/1434) had BI-RADS 3 results after DM and 10.6% (177/1668) after DBT (p < 0.01). Median imaging follow-up after DM was 12 months (IQR 6, 24) versus 18 after DBT (IQR 11, 25), p = 0.02. 19.5% (73/375) of patients were lost to follow-up (19.2% (38/198) after DM (68.4% (26/38) no follow-up after initial exam) versus 19.8% (35/177) after DBT (54.3% (19/35) no follow-up after initial exam). 1.3% (5/375) of patients elected biopsy (1.5% (3/198) after DM and 1.1% (2/177) after DBT). 75.2% (282/375) of patients were downgraded (75.3% (149/198) after DM and 75.1% (133/177) after DBT). 2.5% (5/198) were upgraded after DM and 0.6% (1/177) after DBT. Median time to upgrade was 6 months after both DM and DBT. 0.3% (1/375) of patients with BI-RADS 3 results had cancer on follow-up.ConclusionPatients with prior DBT had a lower risk of encountering BI-RADS 3 findings on screening ultrasound. BI-RADS 3 findings on screening ultrasound had an extremely low rate of being cancer.     

Impact of digital breast tomosynthesis (DBT) on finding types leading to true-positive and false-positive examinations

PurposeTo investigate the frequencies of finding types with combined digital breast tomosynthesis (DBT) and digital mammography (DM) leading to true-positive (TP) and false-positive (FP) examinations.Materials and methodsConsecutive screening mammograms at an academic medical center from March 2008 to February 2011 (DM group) and from January 2013 to December 2017 (DBT/DM group) were retrospectively reviewed. Multivariable logistic regression models were used to compare the proportions of mammographic finding types leading to TP and FP examinations between the two groups.ResultsThe DM group had 554 TP and 7278 FP examinations, and the DBT/DM group had 1271 TP and 14,544 FP examinations. The finding type of calcifications led to a lower proportion of TP examinations in the DBT/DM than DM group (34.3% versus 47.7%, p < 0.001) but also a lower proportion of FP examinations (18.7% versus 21.7%, p < 0.001). Mass led to a higher proportion of TP examinations in the DBT/DM than DM group (5.7% versus 1.3%, p < 0.001) but also a higher proportion of FP examinations (4.6% versus 0.3%, p < 0.001). Asymmetry led to a higher proportion of TP examinations in the DBT/DM than DM group (58.3% versus 50.4%, p = 0.03) and a lower proportion of FP examinations (75.9% versus 77.6%, p < 0.001). Architectural distortion led a similar proportion of TP examinations in the DBT/DM and DM groups (1.7% versus 0.7%, p = 0.12) but a higher proportion of FP examinations (0.8% versus 0.4%, p = 0.007).ConclusionsMammographic findings leading to TP and FP examinations have shifted with the addition of DBT to DM.     

Digital Breast Tomosynthesis Complements Two-Dimensional Synthetic Mammography for Secondary Examination of Breast Cancer

Objective:To compare the performance of two-dimensional synthetic mammography (SM) combined with digital breast tomosynthesis (DBT) (SM/DBT) and full-field digital mammography (FFDM) including women with DBT (FFDM/DBT) undergoing secondary examination for breast cancer.Material and Methods:Out of 186 breasts, including 52 with breast cancers; FFDM/DBT and SM/DBT findings were interpreted by four expert clinicians. Radiation doses of FFDM, SM/DBT, and FFDM/DBT were determined. Inter-rater reliabilities were analyzed between readers and between FFDM/DBT and SM/DBT by Cohen’s Kappa coefficients. Diagnostic accuracy was compared between SM/DBT and FFDM/DBT by Fisher’s exact tests. Two representative cancer cases were examined for differences in the interpretation between FFDM and SM.Results:A higher radiation dose was required in FFDM/DBT than in SM/DBT (median: 1.50 mGy vs. 2.95 mGy). Inter-rater reliabilities were similar between both readers and modalities. Both sensitivity and specificity were equivalent in FFDM/DBT and SM/DBT (p = 0.874–1.00). Compared with FFDM, SM did not clearly show abnormalities with subtle margins in the two representative cancer cases.Conclusion:SM/DBT had a similar performance to FFDM/DBT in detecting breast abnormalities but requires less radiation. DBT complements SM to improve accuracy to a level equivalent to that of FFDM. Taken together, SM/DBT may be a good substitute for FFDM/DBT for the secondary examination of breast cancer.     

Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis

Objective

To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for benign and malignant lesions in breasts.

Methods

Document retrieval was conducted on PubMed, EMBASE, the Cochrane Library, Web of Science and Chinese Biomedical Literature Database, etc., from 1950 to June 2013. Metadisc1.4 software was used to analyse the pooled sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio. The heterogeneity was assessed using forest plots and the inconsistency index (I²). Before statistical comparison, the area under (AUC) the summary receiver-operating characteristic curve (SROC) of two different diagnostic methods was calculated respectively.

Results

A total of seven studies involving 2,014 patients and 2,666 breast lesions were included. Compared with the gold standard (histological results), the pooled sensitivity and specificity of DBT were 90.0 % and 79.0 %, and for DM they were 89.0 % and 72.0 %, respectively. The pooled positive likelihood ratio of DBT and DM was 3.50 and 2.83; the pooled negative likelihood ratio of DBT and DM was 15 % and 18 %; the pooled DOR for DBT and DM was 26.04 and 16.24, respectively.

Conclusions

Digital breast tomosynthesis has a higher sensitivity and specificity in breast diagnosis than digital mammography.

Key Points

? Digital breast tomosynthesis has high sensitivity and specificity in breast diagnosis. ? DBT appears to have superior diagnostic accuracy relative to digital mammography. ? DBT images were captured at a lower dose than 2D images. ? DBT displays abnormal features of lesions more clearly than DM. ? Digital breast tomosynthesis could become the first choice for assessing breast lesions.     

全视野数字乳腺摄影结合乳腺数字体层合成摄影的辐射剂量与压迫厚度及乳房密度的相关性研究

目的 对比分析乳腺数字体层摄影及全数字乳腺摄影（DBT/FFDM）模式平均腺体剂量（AGD）与乳房密度、压迫厚度的关系,探讨不同类型（厚度和密度）乳房在具体情况下摄影方式的优化选择与应用。方法 回顾性分析229例乳房Combo （DBT+FFDM）临床资料,分别收集记录双乳正位（CC）及内外斜位（MLO）压迫厚度、AGD、kVp和乳房量化密度（Q_abd）类型,分析DBT/FFDM模式下压迫厚度、密度与AGD之间的关系。结果 DBT/FFDM模式AGD与压迫厚度（CC位：r=0.55、0.53,P<0.001;MLO位：r=0.62、0.48,P<0.001）、乳房密度（CC位：r=0.36、0.39,P<0.001;MLO位：r=0.16、0.30,P<0.001）正相关;DBT模式AGD组间差异小,FFDM模式AGD组间差异大（厚度分组CC位：F=35.29、31.32,P<0.005;MLO位：F=44.83、27.02,P<0.005;Q_abd分类CC位：F=18.68、19.76,P<0.005;MLO位：F=4.58、10.52,P<0.005）;Q_abd分类高的乳房平均压迫厚度较低（CC位：F=16.28,P<0.005;MLO位：F=17.81,P<0.005）;同时考虑压迫厚度与乳房密度交互作用影响,仅在MLO位DM模式对AGD有交互作用（F=3.16,P=0.005）。结论 DBT/FFDM两种模式剂量累积可能增加辐射风险;乳腺摄影优先采用单视图CC/MLO-DBT或CC/MLO-（DBT+FFDM）+单视图MLO/CC-FFDM模式,在减低辐射剂量风险方面有积极作用。     

Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings

The main purpose was to compare breast cancer visibility in one-view breast tomosynthesis (BT) to cancer visibility in one- or two-view digital mammography (DM). Thirty-six patients were selected on the basis of subtle signs of breast cancer on DM. One-view BT was performed with the same compression angle as the DM image in which the finding was least/not visible. On BT, 25 projections images were acquired over an angular range of 50 degrees, with double the dose of one-view DM. Two expert breast imagers classified one- and two-view DM, and BT findings for cancer visibility and BIRADS cancer probability in a non-blinded consensus study. Forty breast cancers were found in 37 breasts. The cancers were rated more visible on BT compared to one-view and two-view DM in 22 and 11 cases, respectively, (p < 0.01 for both comparisons). Comparing one-view DM to one-view BT, 21 patients were upgraded on BIRADS classification (p < 0.01). Comparing two-view DM to one-view BT, 12 patients were upgraded on BIRADS classification (p < 0.01). The results indicate that the cancer visibility on BT is superior to DM, which suggests that BT may have a higher sensitivity for breast cancer detection.     

Outcomes by Race in Breast Cancer Screening With Digital Breast Tomosynthesis Versus Digital Mammography

PurposeDigital breast tomosynthesis (DBT) in conjunction with digital mammography (DM) is becoming the preferred imaging modality for breast cancer screening compared with DM alone, on the basis of improved recall rates (RR) and cancer detection rates (CDRs). The aim of this study was to investigate racial differences in the utilization and performance of screening modality.MethodsRetrospective data from 63 US breast imaging facilities from 2015 to 2019 were reviewed. Screening outcomes were linked to cancer registries. RR, CDR per 1,000 examinations, and positive predictive value for recall (cancers/recalled patients) were compared.ResultsA total of 385,503 women contributed 542,945 DBT and 261,359 DM screens. A lower proportion of screenings for Black women were performed using DBT plus DM (referred to as DBT) (44% for Black, 48% for other, 63% for Asian, and 61% for White). Non-White women were less likely to undergo more than one mammographic examination. RRs were lower for DBT among all women (8.74 versus 10.06, P < .05) and lower across all races and within age categories. RRs were significantly higher for women with only one mammogram. CDRs were similar or higher in women undergoing DBT compared with DM, overall (4.73 versus 4.60, adjusted P = .0005) and by age and race. Positive predictive value for recall was greater for DBT overall (5.29 versus 4.45, adjusted P < .0001) and by age, race, and screening frequency.ConclusionsAll racial groups had improved outcomes with DBT screening, but disparities were observed in DBT utilization. These data suggest that reducing inequities in DBT utilization may improve the effectiveness of breast cancer screening.